Past few decades have seen vast development as to surgical procedures—minimally invasive surgery being one of the prime advances of this era. Minimally invasive surgeries, such as arthroscopic surgery and laparoscopic surgery, recently have become widely practiced surgical procedures. Such procedures have gained rapid popularity and generally are preferable over the traditional open surgery which requires cutting large incisions through the skin, muscles and membranes to open and expose the body cavity, thereby necessitating longer hospitalization stays and prolonged recovery periods. In minimally invasive surgery, small incisions are made into which tubular conduits, such as cannulae and trocars, are inserted and directed to the site of the operable internal organ or tissue. One or more surgical instruments are introduced, each through individual tubular conduits in order to perform the surgical procedure. It would be obvious to the reader that said minimally invasive surgical procedures including arthroscopy, endoscopy and laproscopy owe their realization to special tools capable of access to intended site of surgery via small incision made to body of patient and operation of which allows precise performance of intended site-specific surgical manipulations.
Cutting, grasping, suturing, cauterization, distension, stapling form commonality of operations in surgery. Minimally invasive surgery tools of art do provide individually for such functions. However, due to the singularity of function accorded by such tools available, the interchange of tools amidst operations and efforts, time required for such becomes unavoidable, besides causing opportunity for complications during repeated insertion and removal of different tools.
In laparoscopic surgery, specialized long thin tools are inserted via air-tight ports fixed on the CO2 inflated abdomen of the patient. The operation area as seen by the endoscope is displayed on an external display where the surgeon views it. Since only a few thin holes are created for inserting tools, this type of surgery results in fewer injuries to the patient, faster healing periods and less cosmetic damage. This type of surgery requires specialized tools that are characterized by their long shafts (usually around 300 mm) and thin cross sections (usually 5-8 mm dia). These tools come in various end-tips, such as scissors, blades, graspers, etc. Procurement/maintenance costs, sterilization requirements of additional equipment are other problems faced by the medical fraternity. Thus, development of minimum invasive surgical tools capable of plural functionality, yet maintaining accuracy, precision and ease of use, are pressing needs of art.
There have been some attempts for resolving said needs of art. Various forms of laparoscopy tools, housings for positioning instruments, extendible blades, multifunctional scissor jaw designs and the like find mention in the art. Many devices which are used commonly for grasping or cutting objects have two elements which can be moved towards one another and away from one another. The elements have surfaces which may be blunt or sharp so that an object positioned between them may be either grasped or cut when the elements are moved towards one another. Examples of such devices include tongs, tweezers, forceps, scissors, guillotines, and wire cutters. Such devices can also be adapted to dissect tissue, for example, by placing the elements of the device into or next to an object and then causing the elements to splay apart thereby dissecting the object. However, these designs have been found to suffer from drawbacks critically affecting their intended function.
U.S. Pat. No. 6,024,744 discloses a combined bipolar scissor and grasper. The instrument disclosed in this patent is a combined bipolar electrosurgical cutting and grasping instrument where the grasping surfaces are contained within the shape of a standard surgical scissor. Accuracy of operation is defined by precise positioning of these portions at site of manipulation. However, being contained within same arm, the cutting and grasping portions are invariably in same angle of motion, thus present risk of accidental cuts or clamps. Also, pivoting of the tool while being inserted is not without risk due to exposed cutting edges.
U.S. Pat. No. 5,397,325 discloses a surgical suturing device which has a tubular elongated shaft terminating into a jaw assembly at the distal end and a handle assembly at the proximal end thereof. The jaw assembly includes a first jaw member pivotally connected to a second jaw member. An actuator rod extending longitudinally within the length of said shaft is connected at its proximal end to said handle assembly and is pivotally connected at its distal end to said jaw assembly. The underside of said first jaw member is provided with a cupped recess having a wheel assembly disposed therein. The wheel assembly includes a needle mount for securely retaining a needle and is configured such that the needle lies within the cupped recess when the jaw members are closed and can be deployed in a protracted position away from the first jaw member when the jaw members are in an open position. In operation, the suturing device offers superior control over both the needle and the tissue to be sutured.
The above mentioned invention suffers from drawback of limited degree of operation due to configuration wherein only one jaw is movable and the other fixed. The said single shaft device presented finds utility for function of suturing having adequate needle control, however, does not offer means to grasp and stabilize the tissue, which is slippery by nature thus mandating that the tissue tending to evade needle carrier manipulation must be grasped by a second instrument. As a result, the surgeon encounters difficulty in controlling and positioning both the needle and the tissue simultaneously, and the patient can suffer complications such as frayed tissue, errant punctures, inadequate stitches, extended surgical duration, hemorrhaging, and the like.
U.S. Pat. No. 5,509,923 describes a device for dissecting, grasping and/or cutting an object has at least two elongate elements at least a portion of at least one of the elements is formed from a pseudoelastic material, preferably a pseudoelastic shape memory alloy. End portions of the elements can be moved away from one another and then toward one another to dissect, grasp and/or cut an object with the elements. In certain embodiments, the device further comprises an actuating means and at least a portion of the elements and/or the actuating means is formed from a pseudoelastic material. The device is intended for applications including dissecting, grasping and/or cutting objects located in difficult to reach areas, within the body during surgery. However, the cutting/grasping members of this tool are pseudoelastic and thus, allow limited degree of choice while deciding on the angle of cut and portion of tissue being grasped. Unintentional nicks and pinches cannot be ruled out are limitations in rotational ability of the tool proposed.
Laparoscopic Scissor Grasper, a product by Interventional and Surgical Innovations LLC is a minimally invasive surgery tool that can both cut and grasp with aid of two jaws having mated via serrations along their inner surfaces. The jaws separate along two axes apart and sideways to provide grasping and cutting functions respectively. However, this design is subject to certain shortcomings as the grasping serrations are invariably exposed while shearing. Also, pivoting of the jaws about their longitudinal axis is not possible. Also, for cutting edge to work, the chamfered edges necessarily need to press against each other. This pressure is enabled by forging a slight curvature in cutting arms being pressed at pivot by means of rivet or other tightening means. Over period of use, this arrangement looses its original construction leading to either loss of pressure of cutting arms or distancing of said cutting arms which ultimately leads to firstly loss of cutting functionality and secondly, presence of two sharpened (chamfered) edges which act as knives and can cut whether intended or not. Such occurrence, is thus compromise to application intended.
U.S. Pat. No. 5,133,727 discloses radial jaw biopsy forceps which feature a multi element head having a fixed blade juxtaposed between two grasper jaws having mated serrations along their internal edges for grip. However, this design too has shortcomings of limited scope for movement and accidental cuts to material in space between the grasping arms while performing delicate functions.
By and large, innovations cited have not been able to overcome the problems of the art. Design of a pluri-functional device for achievement of surgical operations is a pressing need of the art. The present inventor has undertaken specific research and has arrived at novel construction and operability of a device for addressing said problems of art. The following brief description presents one non-limiting embodiment of constructing and performing the present invention.